CITY OF LOS ANGELES PUBLIC EMPLOYEE
DISASTER SERVICE WORKER PROGRAM
OATH OF LOYALTY
Government Code §3100
It is hereby declared that the protection of the health and safety and preservation of the lives and
property of the people of the state from the effects of natural, manmade, or war-caused emergencies
which result in conditions of disaster or in extreme peril to life, property, and resources is of paramount state
importance requiring the responsible efforts of public and private agencies and individual citizens. In
furtherance of the exercise of the police power of the state in protection of its citizens and resources, all
public employees are hereby declared to be disaster service workers subject to such disaster
service activities as may be assigned to them by their superiors or by law.
Government Code §3108-3109
Every person who, while taking and subscribing to the oath or affirmation required by this chapter, states
as true any material matter which he or she knows to be false, is guilty of perjury, and is punishable by
imprisonment in the state prison for two, three, or four years. Every person having taken and subscribed
to the oath or affirmation required by this chapter, who, while in the employ of, or service with, the state or
any county, city, city and county, state agency, public district, or disaster council or emergency
organization advocates or becomes a member of any party or organization, political or otherwise, that
advocates the overthrow of the government of the United States by force or violence or other unlawful
means, is guilty of a felony, and is punishable by imprisonment in the state prison.
OATH OF LOYALTY (GOVERNMENT CODE §3102)
Antoinette Anderson
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do solemnly swear (or affirm) that I will support and defend the Constitution of the United States and
the Constitution of the State of California against all enemies, foreign and domestic; that I will bear
true faith and allegiance to the Constitution of the United States and the Constitution of the State of
California; that I take this obligation freely, without mental reservation or purpose of evasion; and that I
will will and faithful! dis arse the duties upon which I am about to enter.
Member, South Los Angeles
Area Planning Commission
DEPARTMENT
7)/6° V,
DATE
WITNESS
Employee's signature must be acknowledged by the City Clerk, Deputy City Clerk, a Department
Representative who is authorized by the City Clerk to administer the Oath of Loyalty, or a Notary Public
who is not permitted by law to charge a fee for this service.
Subscribed and sworn to before me on
DATE
Deputy City Clerk
SIGNATURE OF CITY CLERK or
OFFICIAL AUTHORIZED TO ADMINISTER LOYALTY OATH
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TITLE
Once taken, the Oath of Loyalty is effective for the entire period of time the signer remains a public employee with
the City of Los Angeles.
Form 132b (Revised 10/12)
Read carefully, sign, and return to your supervisor or appointing authority.
CODE OF ETHICS
I have received a copy of the City's Code of Ethics as contained in the Resolution adopted by the
City Council on July 21, 1959 and amended August 23, 1979 by Council Resolution, I have read
and understand the intent of this Code, and I will apply it in my duties with the City.
Antoinette Anderson
SIGNATURE
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DATE
FEDERAL PRIVACY ACT
Use of Social Security Numbers
Federal law (Title 5 United States Code section 552a, subdivision (e)(3)) requires you be informed of
the following when asked to supply your Social Security number:
(A) the authority which authorizes the solicitation of the information and
whether disclosure of such information is mandatory or voluntary;
(B) the principal purpose or purposes for which the information is intended to
be used;
(C) the routine uses which may be made of the information; and
(D) the effects, if any, of not providing the requested information
This is to inform you that when, as an official/employee of the City, you are requested to supply
your Social Security number on any department form, disclosure of such information is mandatory
and it is required for use in the employment, personnel or payroll process. The authority for
requiring this information is based upon provisions of the City's payroll and personnel candidate
processing systems and applicable Federal Law.
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SIGNATUR
Form 132a (Revised10/12)
Antoinette Anderson
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DATE